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Study design: Literature review. Objectives: To map traumatic spinal cord injury (TSCI) globally and provide a framework for an ongoing repository of data for prevention. Setting: An initiative of the ISCoS Prevention Committee. Methods: The results obtained from the search of Medline/Embase using search phrases: TSCI incidence, aetiology, prevalence and survival were analysed. Stratification of data into green/yellow/red quality 'zones' allowed comparison between data. Results: Reported global prevalence of TSCI is insufficient (236-1009 per million). Incidence data was comparable only for regions in North America (39 per million), Western Europe (15 per million) and Australia (16 per million). The major cause of TSCI in these regions involves four-wheeled motor vehicles, in contrast to South-east Asia where two-wheeled (and non-standard) road transport predominates. Southern Asia and Oceania have falls from rooftops and trees as the primary cause. Highfall rates are also seen in developed regions with aged populations (Japan/Western Europe). Violence/ self-harm (mainly firearm-related) was higher in North America (15%) than either Western Europe (6%) or Australia (2%). Sub-Saharan Africa has the highest reported violence-related TSCI in the world (38%). Rates are also high in north Africa/Middle East (24%) and Latin America (22%). Developed countries have significantly improved TSCI survival compared with developing countries, particularly for tetraplegia. Developing countries have the highest 1-year mortality rates and in some countries in sub-Saharan Africa the occurrence of a spinal injury is likely to be a fatal condition within a year. Conclusion: Missing prevalence and insufficient incidence data is a recurrent feature of this review. The piecemeal approach to epidemiological reporting of TSCI, particularly failing to include sound regional denominators has exhausted its utility. Minimum data collection standards are required.

Study design: Literature review. Objectives: Globally map non-traumatic spinal cord injury (NTSCI) incidence, prevalence, survival, level of injury and aetiology. Propose a research framework for NTSCI prevention and launch a repository of NTSCI data. Setting: Initiative of the International Spinal Cord Society Prevention Committee. Methods: Literature search of Medline and Embase (1959-June 2011). Relevant articles in any language regarding adults with NTSCI were included. Stratification of information about incidence and prevalence into green/yellow/orange/red data quality 'zones' and comparisons between World Health Organisation (WHO) regions and countries. Results: Three hundred and seventy-seven abstracts reviewed-45 of these from 24 countries in 12 of the 21 WHO global regions had relevant information. Only one publication had survival data. Prevalence data for NTSCI existed for only two countries, India (prevalence of 2 310/million population, Kashmir region) and Canada (prevalence of 1 120/million population). The incidence rates for WHO regions were: Asia Pacific, high income 20/million population/year; Australasia (26/million population/year); Western Europe median of 6/million population/year; North America, high income median 76/million population/year (based on poor-quality studies); and Oceania 9/million population/year. Developed countries tended to have a higher proportion of cases with degenerative conditions and tumours. Developing countries, in comparison, tended to have a higher proportion of infections, particularly tuberculosis and HIV, although a number also reported tumours as a major cause. Conclusions: Insufficient survival, prevalence and incidence data are a predominant finding of this review. The piecemeal approach to epidemiological reporting of NTSCI, particularly failing to include sound regional population denominators, has exhausted its utility. Minimum data collection standards are required.

Study design: Retrospective study. Objectives: To review traumatic spinal cord injury (TSCI) rates and epidemiology at the Riyadh Military Hospital (RMH) in Saudi Arabia and to hypothesise strategies for a more integrated approach to injury prevention in Saudi Arabia. Setting: RMH, Rehabilitation Division. Methods: A review was conducted of all patients with TSCI aged X14 years admitted to RMH from January 2003 to December 2008. Descriptive analysis was performed for age, gender, cause of TSCI, completeness and neurological level of the injury. Results: In all, 307 TSCI patients were admitted during this period: 88% were male, and their mean age was 29.5 years old (median 27, range 14-70). Of all TSCI patients, 52% had tetraplegia and 51% had a complete TSCI. Road traffic accidents (RTAs) were the main cause of TSCI (85%). Conclusions: TSCI in Saudi Arabia affects mainly the male population. The rate of RTAs caused by four-wheeled vehicles is the highest globally reported RTA statistic. Primary prevention strategies specific to the region should be developed to decrease the number of car accidents. The higher-than-expected rate of complete injuries may reflect practices in acute management and transport, and suggests that a review of the acute and integrated management of TSCI may also be necessary.

Understanding the incidence of TSCI is important for health service planning and for the determination of injury prevention priorities. In the absence of high-quality epidemiological studies of TSCI in each country, the estimation of TSCI obtained through population modelling can be used to overcome known deficits in global spinal cord injury (SCI) data. The incidence of TSCI is context specific, and an alternative regression model demonstrated how TSCI incidence estimates could be improved with additional data. The results highlight the need for data standardisation and comprehensive reporting of national level TSCI data. A step-wise approach from the collation of conventional epidemiological data through to population modelling is suggested.

Objectives: To estimate trends in incidence rates of rugby code‐related severe cervical spinal cord injuries in New South Wales (NSW) from 1986 to 2003. To evaluate the Australian Spinal Cord Injury Register (ASCIR) for injury surveillance by comparison with two published studies. Methods: Data were cases of complete and incomplete tetraplegia in rugby union and rugby league admitted to the two spinal units in NSW. Trends in incidence rates were estimated using Poisson regression modelling. Results: There was a small, nonsignificant decline from 1986 to 2003 in the incidence rate of tetraplegia in rugby union (9.8 vs. 6.1 per 100,000 player‐years; p=0.378) and rugby league (2.3 vs. 1.6 per 100,000 player‐years; p=0.564). The most common causes of injury were scrums for rugby union (35%) and tackles for rugby league (78%). This did not change over time (rugby union, p=0.118; rugby league, p=0.288). The ASCIR identified more cases of tetraplegia than insurance claims data and at least 75% of the cases ascertained by medical record review. Conclusions: There remains an urgent need to further improve safety in rugby union and rugby league. Scrummage in union and tackles in league remain the leading causes of tetraplegia. Rates of tetraplegia were significantly higher and more variable in rugby union than in rugby league. Implications: The ASCIR is a useful tool to monitor trends in spinal cord injury incidence in both rugby codes. Its potential value is constrained by the lack of accurate estimates of player numbers.

Study design: An end-user response survey and assessments of inter-rater reliability before and after training. Objectives: Evaluate the spinal cord injury (SCI) application of the international classification of external cause of injury (ICECI) in a mixed group of untrained and trained coders to assess agreement, refine coding and training methodology. Setting: An interactive coding workshop for an international group of coders with varying previous training. Methods: Evaluate content validity (qualitative survey) and inter-rater reliability (kappa estimate of agreement) of the ICECI in a variety of injury scenarios presented within a computerized data-entry and training module. The results of this evaluation are compared with an earlier published gold standard. Results: The ICECI is a flexible data coding system that appears to work with reasonable content validity in the regions assessed with English-language coders. Training appeared to narrow the difference between the inexperienced and trained coders. This is reflected in a borderline tendency for lower kappa scores pre-training compared with an earlier examined group of expert coders (P ¼ 0.073) but no difference in kappa scores after training (P ¼ 0.67). Computer-based training on a face-to-face level with computerized data entry appears an effective tool for training coders to use the ICECI. Conclusions: This report shows that using electronic data-entry and training assistance, inexperienced coders using the SCI-ICECI computerized system quickly approach the levels of agreement of trained coders in related data systems. The content validity of the training data set is adequate but needs to include more cases representative for use in SCI.

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